Provider Demographics
NPI:1922274430
Name:BAILL, I CORI (MD)
Entity Type:Individual
Prefix:DR
First Name:I
Middle Name:CORI
Last Name:BAILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2702 N ORANGE AVE
Mailing Address - Street 2:STE A
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4667
Mailing Address - Country:US
Mailing Address - Phone:407-898-8990
Mailing Address - Fax:407-895-4987
Practice Address - Street 1:2702 N ORANGE AVE
Practice Address - Street 2:STE A
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4667
Practice Address - Country:US
Practice Address - Phone:407-898-8990
Practice Address - Fax:407-895-4987
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-05
Last Update Date:2013-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0061484207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18222OtherBCBS FL
FL18222OtherBCBS FL
FL18222XMedicare PIN